Integrated health care

Studies have begun to confirm the relationship between good physical health and good mental health. Hartford, Conn.-based Aetna studied a group of 36,747 workers from 2002 to 2004 who were out on disability for a variety of illnesses, such as irritable bowel syndrome (IBS), chronic fatigue, hypertension, back pain, obesity and carpal tunnel syndrome. The study examined those who were out on a disability and also were diagnosed with depression, and it found that workers with depression were out on disability for a longer period than those who were not diagnosed with depression. For example, depressed workers diagnosed with IBS experienced an average of 63 percent longer disability durations than workers with IBS who were not depressed. Additionally, the study found that back pain claims resulted in disability duration that was, on average, 25 percent longer for claimants with depression than for workers who were not depressed.

Aetna developed an approach, known as integrated health and disability, to allow case managers to share information, with the employee's permission, that would otherwise be kept separate. The approach resulted in the employee reducing short-term disability durations, saving as much as $300 per claim, according to the company.

Such results do not surprise Antonucci, who co-authored an APA study of the benefits of integrated health care. The study outlined the challenges and benefits of building teams of providers who address multiple aspects of a patient's condition. Psychologists have a role in the teams, she says, because they often can provide a context for the health issues that physicians, who focus only on the physical symptoms, can sometimes miss. “People need to talk to each other,” Antonucci explains. “Sometimes there are psychological manifestations of physical issues, and sometimes it's a physical manifestation of psychological issues.”

In addition to the physical benefits of better treatment of chronic illness, there also are budgetary benefits. Diseases cost the U.S. economy more than $1 trillion annually, most of which is attributed to lost productivity, according to a study by the Santa Monica, Calif.-based Milken Institute, a non-profit studying chronic illness. The institute says economic costs could grow to $6 trillion by mid-century if left unchecked. The most important factor in reducing the effect of the health costs, the Milken Institute study reports, is obesity, which, if rates declined, could annually lead to $60 billion less in treatment costs and $254 billion in increased productivity.

Health costs still will increase

High Point, with 1,500 full- and part-time employees, has increasingly placed a priority on holistic health care, McCrary says. City officials have accepted that year-over-year health costs will inevitably continue to increase, given inflation, new and costly technologies, and expensive improvements in the ability to treat diseases that once were considered incurable, he says. “We'll never see where costs are less in one year than the prior year,” he says. “But, if people moderate their behavior and keep their conditions under control, the program will pay dividends years from now.”

High Point's employee health care system is centered on its health clinic, which initially performed routine services, like physicals for new hires, sick calls and substance abuse testing, McCrary says. But, the clinic has adopted a new role to educate employees on better decision making for their lifestyles, such as smoking cessation and better nutrition. More recently, the clinic has assumed an additional function as a resource for employees who want to take aggressive steps to improve their physical condition and their mental outlook.

The city's weight loss program has attracted 15 percent of employees, helped by an incentive from the city of $50 per year if the participant does not gain weight. In addition to support groups, the program has incorporated walking into the program on employer time. It has become so successful that the biggest concern is that the carpets in the halls are wearing out. “People wanted to lose weight and feel better about themselves,” McCrary says. “The city benefits as a byproduct. When people feel better, it improves morale.”

McCrary has seen a significant change in how employees who participate in the program approach their lives. “Some were depressed about their weight and their physical appearance,” he says. “They were short of breath when they climbed a flight of stairs. They're not depressed about these things anymore.”

No Ralph Kramden here

At the Fort Worth Transportation Authority, Aetna now covers long-term disability care and medical services, so a case manager can ensure that employees receive comprehensive treatment. “It's easier for the employee to get benefits promptly,” says Kroecker, human resources director. “It's easier to recuperate, receive personalized service.”

She notes that only a limited number of employees are off duty because of a disability, but those who are and also have depression are treated for both. “It's not just physical,” Kroecker says. “It's behavioral as well. It's integrated right into the program. It's working.”

The transportation authority also has a fitness center that is open around-the-clock, with a health and fitness coordinator who manages the wellness program. About 175 of the 560 employees are actively participating in the center's programs, and a group of a similar number use some part of the services available. “We have a rough work environment [for health],” Kroecker says. “It's a bus service, and it's a very sedentary job. Workers like being a member of the fitness center. They use it during their down time to stay physically fit.”

In addition to the fitness activities, the transportation authority also has a full schedule of wellness activities, including yoga and tai chi. It also offers classes on diabetes and heart disease and other behavior-related health problems.

While High Point and Fort Worth Transportation have built programs that incorporate the mental health of their employees into their health care benefits, their approach is the exception rather than the rule, Brehm notes. “There's a lot of talk about national health care but not much action,” she says of the political debate about Americans' access to the health care system. “The issue of integrated health care is a big one. It's obvious that people should have access to universal care. Getting them into an integrated setting may be a piece included in a very complex system. It's a very important topic.”

Robert Barkin is a Bethesda, Md.-based freelance writer.